Learning to give a painless, anxiety-free pelvic exam

A speculum - looks like a torture device, but it is NOT supposed to hurt!

Warning: this post contains graphic information and is not for the squeamish.

As every woman knows, a pelvic exam is the most invasive part of the physical exam. If it’s not performed perfectly, it can cause a lot of physical pain, anxiety, and humiliation.

Similarly to how we learned male genital exams, we learn to perform female pelvic exams by performing them on our teachers. Two women, who teach pelvic exams to med students for a living, paired up with myself and two of my classmates to review the exam.

I think I have the best doctor in the world, but I have never gotten a pelvic exam as intricate as the one we were taught. First of all, you are supposed to hand the patient a mirror, so that they can watch and feel like they are participating in what’s going on down there. Using a strategically placed light, next you use the shadow of your finger to point out the different parts of the woman’s anatomy and teach her what’s what. Our teachers said the majority of women don’t know their own genital anatomy, and many have never even looked at it! So the pelvic exam provides a good opportunity for some patient education.

The next thing you do is insert a finger in the vagina and check the glands. While you’re there, you ask the woman to do a Kegel (this is when you squeeze the muscle in your vagina, like you’re stopping a stream of urine), to check the strength of the vaginal wall muscles. My teacher must hold some sort of world record for vaginal muscle strength. I swear I could feel blood flow to my finger stop for a few seconds when she did her Kegel. I guess she probably does a lot of them in her line of work.

Next we learned how to perform the dreaded speculum exam. Even though it looks like a torture device, it is not supposed to hurt when you put it in. If it does hurt, our teacher told us, the physician’s technique is wrong. To my excitement, I was able to put in the speculum and visualize the cervix pretty easily, without hurting my teacher! The last part of the pelvic exam is the bimanual exam, where you can feel the uterus and the ovaries by maneuvering them between one hand that is on the abdomen and another hand that is in the vagina. This was absolutely amazing to me.

Finally, we learned that a major component of a good pelvic exam is not what you do, but what you say. One of our professors told us that most women need to be reassured that their vagina is normal. Although men have typically seen lots of penises in their lives (being a completely external organ and all), some women have never, ever seen a vagina. Without that basis for comparison, there is a lot of anxiety about what is normal and what is not. We were told to reassure our patients that everything appears to be normal (unless, of course, it isn’t). We were also taught certain words to avoid during the exam to reduce anxiety – don’t say feel, say examine; don’t say spread your legs, say relax your knees, don’t say stick in and pull out, say insert and remove.

Besides constantly being afraid that I was hurting my teacher or doing something wrong, I had a wonderful experience learning to perform the pelvic exam. Which is a good thing, since in any of my top three interests right now (OB-GYN, Family Medicine/Women’s Health, ER), there are a lot of pelvic exams in my future!